caa a22 4500 445333359 CHVBK 20180317142744.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1245/s10434-010-1507-0 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1507-0 4D Parathyroid CT as the Initial Localization Study for Patients with De Novo Primary Hyperparathyroidism [Elektronische Daten] [Lee Starker, Amit Mahajan, Peyman Björklund, Gordon Sze, Robert Udelsman, Tobias Carling] Background: Preoperative localization of parathyroid tumors of primary hyperparathyroidism (pHPT) is required for minimally invasive parathyroidectomy (MIP). Parathyroid four-dimensional computed tomography (4DCT) has mainly been used as an adjunct to other imaging modalities in the remedial setting. 4DCT was evaluated as the initial localization study in de novo patients with pHPT. Materials and Methods: A total of 87 consecutive patients underwent parathyroidectomy for pHPT from August 2008 to November 2009. 4DCT was introduced as the preferred imaging modality instead of sestamibi with SPECT (SeS) in April 2009. Results of the imaging studies [4DCT, SeS, and ultrasonography (US)], operative and, pathologic findings, and biochemical measurements were evaluated. Results: In this study, 84% of patients (73 of 87) underwent an US, 59.8% (52 of 87) a SeS, and 38.0% (33 of 87) had a 4DCT. 4DCT had improved sensitivity (85.7%) over SeS (40.4%) and US (48.0%) to localize parathyroid tumors to the correct quadrant of the neck (P<0.005) as well as to localize (lateralize) the parathyroid lesions to one side of the neck (93.9% for 4DCT vs. 71.2% for US and 61.5% for SeS; P<0.005). 4DCT correctly predicted multiglandular disease (MGD) in 85.7% (6 of 7) patients, whereas US and SeS were unable to detect MGD in any case. All patients achieved cure based on intraoperative parathyroid hormone (PTH) measurements and normalization of intact PTH and S-Ca during follow-up. Conclusions: 4DCT provides significantly greater sensitivity than SeS and US for precise localization of parathyroid tumors of pHPT. Additionally, it correctly predicted MGD in a majority of patients. Society of Surgical Oncology, 2010 Starker Lee Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut Mahajan Amit Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA aut Björklund Peyman Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut Sze Gordon Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA aut Udelsman Robert Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut Carling Tobias Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut Annals of Surgical Oncology Springer-Verlag 18/6(2011-06-01), 1723-1728 1068-9265 18:6<1723 2011 18 10434 https://doi.org/10.1245/s10434-010-1507-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1507-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Starker Lee Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut NATIONALLICENCE 700 1- Mahajan Amit Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA aut NATIONALLICENCE 700 1- Björklund Peyman Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut NATIONALLICENCE 700 1- Sze Gordon Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA aut NATIONALLICENCE 700 1- Udelsman Robert Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut NATIONALLICENCE 700 1- Carling Tobias Department of Surgery, Yale University School of Medicine, New Haven, CT, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/6(2011-06-01), 1723-1728 1068-9265 18:6<1723 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer